Reform of the American Health Care System is Still Achievable

The system millions of seniors rely upon to meet critical health care needs is failing them. And if many in Washington have their way, the fatal flaws of our nation’s Medicare system could additionally threaten access to quality care for every American.

As a former physician, I can attest that perhaps nothing has had a greater negative impact on health care in this country than governmental and regulatory intrusion, primarily through Medicare. Yet, many dangerously see Medicare as the blueprint for national health care reform.

The failings of Medicare are many. In terms of cost, quality, and access, the system consistently comes up short. In sum, it is not focused on patients. Their needs routinely fall victim to bureaucratic and inflexible regulations, one-size-fits-all policies, and a flawed payment system that limits access to care.

It is this defective payment system that Congress is grappling with today. Without action by the end of this month, access to health care for our nation’s seniors will be put in jeopardy, as Medicare will automatically slash reimbursements for patient care. The cuts would leave doctors increasingly unable to accept and treat Medicare patients.

Right now, physicians of Medicare patients are required to sign annual contracts with the government, stipulating every aspect of care they may – and may not – offer through the program. After a patient is treated, care is reimbursed at a cost predetermined by a federal formula, the Medicare Sustainable Growth Rate or SGR. Not surprising to many, this formula has little to do with actually providing treatment. Instead of ensuring patients needs are covered, it primarily functions to control utilization and regulate the cost per patient.

Following this SGR formula, Medicare annually estimates a level of medical services it assumes will be required the following year. It arbitrarily presumes that any growth in health care spending should be equal to growth in the gross domestic product. Should health care spending in that year grow more than the economy, the SGR automatically triggers a cut in reimbursements for patient care the following year.

Since SGR’s inception, never once have patients’ needs come inline with the formula’s prediction. And every year physicians are subjected to potential reimbursement cuts. Recent cuts have been staved off through congressional action, but a system that automatically punishes increased access to health care with fewer resources is a system that is terribly broken.

These reduced reimbursements make it financially impossible for many doctors to treat Medicare beneficiaries, leaving our seniors with fewer options to meet their needs. Most medical practices, including some of the most respected in the nation, already find it necessary to limit the number of Medicare patients they see – all because of the federal government.

To make matters worse, we face a coming demographic tidal wave with millions of Baby Boomers beginning to enter the Medicare system. In the following years, Medicare needs are expected to soar, yet due to the flawed SGR formula, the system will offer fewer and fewer options for patients. While more seniors will technically be covered, government rationing means patients will be increasingly limited in permissible procedures and doctors they may see.

Among countless others, this problem stands as just one example of why Medicare, in fact our entire health system, needs patient-centered reform, not more of these federal “solutions.” Yet amazingly, many in Washington believe if only more Americans were covered by Medicare, all our health care problems would be solved.

Drawing on decades as a physician, this notion is unrealistic and irresponsible. Yet positive, fundamental reform of the American health care system is still achievable – in a way that puts patients first.

Two pillars are necessary to move us in the right direction. First, we must ensure it makes financial sense for all Americans to be insured. This may be readily accomplished through the adoption of tax equity for the purchaser of insurance, active pooling mechanisms for increased purchasing power, and focused reform of tax deductions and credits. Second, insurance should be owned and controlled by the patient. Regardless of who is paying the bill – government, employer, or individual – patients should be able to decide what coverage and care is best suited for their individual needs. Such a system will provide the accountability, responsiveness, and flexibility needed to ensure quality care, ready access, and necessary efficiencies.

Restoring the power of patients in our health care system is the best way to ensure Americans have quality care throughout the 21st century. It will only occur if we re-establish a process that best serves those most affected – patients!